Microscopic features of lichen sclerosus et atrophicus in acrochordons: a clue to the cause of lichen sclerosus et atrophicus?

Abstract

The cause of lichen sclerosus et atrophicus (LSA) is unknown, but on the penis it is associated with chronic occlusion, that is, phimosis. Microscopic changes of LSA were seen unexpectedly in two acrochordons. Our purpose was to further characterize this phenomenon. A total of 449 acrochordons examined in our histopathologic laboratory in the past 2 years were studied for changes of LSA, and clinical data were collected. Eight additional cases were found. All of the acrochordons exceeded 0.5 cm, and three were 1 cm or larger. At least six were under chronic occlusion or pressure. The dermal changes of LSA predominated over the epidermal changes. All showed collagenous homogenization, sclerosis, and inflammation. Elastic fibers were characteristically decreased. These observations strengthen the evidence that LSA in flaccid skin may be caused by chronic occlusion.